A Case of Acquired Amegakaryocytic Thrombocytopenia Responding to Immunosuppressive Therapy / 대한혈액학회지

Acquired amegakaryocytic thrombocytopenia is a relatively rare bone marrow failure disorder characterized by severe thrombocytopenia associated with a total absence or a marked reduction in the number of bone marrow megakaryocytes. We report a case of acquired amegakaryocytic thrombocytopenia. A 39-year old man admitted our hospital because of gingival bleeding and purpura on the thigh, his initial complete blood cell counts were white blood cell 5.6 103/micro liter hemoglobin 9g/dL, and platelet 1 103/micro liter On the bone marrow study, megakaryocyte was not observed and cytogenetic analysis of marrow was 46, XY, inv(9). (p11q13). Other autoimmune markers were negative. The patient received steroid therapy during 8 weeks, but there was no significant improvement and then he received immunosuppressive therapy with antithymocyte globulin and cyclosporin-A. Thereafter the platelet count increased to 80 103/micro liter, and this level continued for 10 months

Recurrence of Subacute Thyroiditis: Report of Two Cases / 대한내분비학회지

Subacute thyroiditis is a self-limited inflammatory disease of viral etiology. Patients of subacute thyroiditis usually recover completely with no sequelae and recurrences are infrequent. We report two cases of recurrent subacute thyroiditis. Case 1) A 21-year-old female visited the hospital for evaluation of neck pain. She had a history of antecedent upper respiratory infection, which had been followed for 10 days. She experienced heat intolerance, sweating, palpitation and tremor. On physical examination, her heart rate was 108/min and diffuse, firm and tender goiter was palpated. Thyrotoxicosis and decreased uptake on thyroid scan were found. We diagnosed subacute thyroiditis and she recovered with salicylate and beta blocker treatment. Two years later, she revisited our hospital with the same complaint. Typical findings of subacute thyroiditis were noticed. She recovered once more with the same treatment regimen. Case 2) A 54-year-old female visited the hospital for evaluation of neck pain. She had a history of antecedent upper respiratory infection, which was followed for 14 days. She experienced heat intolerance, sweating, palpitation and weight loss. On physical examination, her heart rate was 112/min and diffuse, firm and tender goiter was palpated. Thyrotoxicosis and decreased uptake on thyroid scan were found. We diagnosed subacute thyroiditis and recovered with prednisolone and beta blocker treatment. About eight months later, she revisited our hospital with the same complaint. Typical findings of subacute thyroiditis were noticed.We report two subjects who experienced recurrent episodes of subacute thyroiditis separated by periods of 24 and 8 months. These cases serve as a reminder that recurrence of subacute thyroiditis can occur.

Association between Non-alcoholic Fatty Liver and Metabolic Diseases / 대한내분비학회지

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is known to be frequently associated with obesity, type 2 diabetes and dyslipidemia. Recently, the diagnosis of fatty liver disease, based on ultrasonographic findings, has increased. Therefore, we examined the association between NAFLD and various metabolic diseases, such as obesity, glucose intolerance, dyslipidemia, and hypertension or metabolic syndrome, and tried to find out whether NAFLD was independently related to insulin resistance. METHODS: From April to June 2000, 262 subjects, attending for routine physical check-ups, were screened. Of these, 115 one hundred fifteen subjects were studied, with the other 147 excluded due to significant alcohol consumption, evidence of viral or toxic hepatitis, significant liver or renal dysfunction, and overt thyroid disease. Fatty liver was diagnosed if the subject had a "bright" liver on ultrasonographic examination. All diagnoses were made by a single experienced radiologist. RESULTS: Of the 115 subjects. 30 (26%) showed NAFLD. 1. Systolic and diastolic blood pressures, body weight, serum total cholesterol, triglyceride, fasting insulin levels and HOMA IR (homeostasis model assessment insulin resistance index) were higher in the subjects with NAFLD than in the controls. 2. Multiple logistic regression analysis, including age, sex, BMI, waist to hip ratio, fasting serum glucose, lipids and insulin levels, HOMA IR, and hypertension showed that BMI, total cholesterol and HOMA IR were independently related with NAFLD. 3. 27% of the subjects with NAFLD showed metabolic syndrome, and 53% of subjects with metabolic syndrome had NAFLD. 4. The percentage of subjects who had more than two factors of metabolic syndrome was three times higher in the subjects with NAFLD compared to the controls. CONCLUSION: These results suggest that NAFLD may be independently related with insulin resistance. Metabolic diseases, such as glucose intolerance, obesity, dyslipidemia and hypertension, were more prevalent in the subjects with NAFLD than in the controls. Therefore, we should try to assess the status of the metabolic diseases, and treat them in patients with NAFLD.